Pharm - Psych - Anti-Depressants

korkisj's version from 2018-02-27 19:26

Section 1

Question Answer
"ABC" drugs that can cause depressionAccutane (Isotertinoin), Beta-Blockers (clonidine, Methyldopa), Corticosteroids (prednisone, ACH)
L-DOPA, Oral contraceptions, Interferone alpha, anticancer drugs, Alcohol
Atypical Depression treated withMAOIs - Phenelzine (Nardil), Selegiline Patch (Emsam)
Contraindicated in patients with seizuresBupropion - Lowers seizure threshold. TCA
Augmentation (adding more drugs) is used when the drug of choice is not working for a pt's depression, one can expect these consequences↑cost (more drugs), ↑side effects (more drugs), ↓compliance (more pills)
Higher overdose potential - is your patient a high suicide risk?TCAs
Older antidepressants less well tolerated in elderly with side efffectsTCAs
High therapeutic doses of this class of drugs can act as P450 inhibitors and may see drug interactionsSSRIs - drug interactions a potential issue if patient on other drugs
Don’t mix Triptans (migraine med) w/ SSRIs or SNRIsSerotonin Syndrome
when combining SSRI with MAOIs, TCAs, Many opioids (increase 5HT neurotransmission), CNS Stimulants (ephedrine, cocaine, etc) you may see these side-effectsSerotonin excess (may lead to Serotonin Syndrome)
What antibiotic has the potential to produce Serotonin Excess side effects when given to a patient taking anti-depressants?Linezolid - inhibits the action of monoamine oxidase A—an enzyme responsible for breaking down serotonin in the brain (drug interaction with adrenergic or serotonergic drugs, e.g. SSRI antidepressants, & tyramine containing foods)
St. John’s wort as an anti-depressant has the opposite ("Anti") effect on P450 as SSRIs, how?Cyp450 inducer
Giving SSRIs to a patient with Bipolar Disorder may have the unintended effect of "Flipping" the patient into a period of Manie (DIGFAST) = SSRIs (antidepressants) “can” unmask mania in patients with a bipolar disorder
Mnemonic for mania - "D.I.G.-F.A.S.T."Distractibility, Insomnia, Grandiosity, Flight of ideas, Activity increased, Sleep (decreased need for), Talkitiveness (pressured speech)

Section 2

Question Answer
Prototype SSRI, has longest Half-life due to an active metaboliteFluoxetine
SSRI that may have withdrawal symptoms can be bad, Must discontinue slowly, due to its short half-life and elimintationParoxetine
Teratogenic - Small increase in the risk for heart defectsParoxetine
Name the SSRIs in "Flashbacks paralyze senior citizens"Fluoxetine, paroxetine, sertraline, citalopram (and Escitalopram = Lexapro)
Good for non-compliant patientsFluoxetine - Longest half-life
Less potential for drug interactins due to its effect on limited isozymes of P450Sertraline (Zoloft)
Stereoisomer with fewer side effectsEscitalopram (Lexapro)
SSRI Side Effects mnemonic "S.S.R.I.s."Sick stomach, Sexual dysfunction, Restlessness (agitation), Insomnia, Serotonin syndrome, BUT including problems with orgasm, weight gain/loss, and headaches
These two SSRIs are strong inhibitors of P450Fluoxetine & Paroxetine
This SSRI needs a washout period once therapy has stopped, this must be considered when recommending other meds to avoid Drug interactionsFluoxetine

Section 3

Question Answer
Contraindicated in patients with seizuresBupropion - Lowers seizure threshold
Do not give to patients with eating disordersBupropion - Increase risk of seizures in these patients
Seizure risk from greatest to leastBupropion > TCAs >> SSRIs (Dont forget about Li toxicity)
Less Sexual Dysfunction, added on to other anti-depressants sexual dysfunction, and may have benefits for smoking cessationBupropion
SNRI - Benefit for patients with Comorbid chronic painDuloxetine
NDRIBupropion (Wellbutrin)
SNRI - known to commonly produce a withdrawal syndrome upon sudden stoppageVenlafaxine (Effexor)
Contraindicated in patients with seizuresBupropion - Lowers seizure threshold
Side Effects of this drug include polydypsia, polyuria*, edema,weight gain, sedation, thyroid enlargement, hypothyroidism (5%)Lithium
Must Avoid dehydration, and may see toxicities such as nausea & vomiting, Higher doses seizures, circulatory collapse, comaLithium
Accumulates in cells of the collecting duct & causes a resistance to the effects of ADHLithium
Alternative drugs for bipolar disorderAntiepileptics & atypical antipsychotics - The mania is thought of as a seizure of overactivity
Narrow TI, biphasic pharmacokinetics – 50% excreted in 12hrs; 50% in 1-2 wksLithium